TOPCAT: Spironolactone in heart failure with preserved ejection fraction

The aldosterone blockade has shown benefit in the treatment of heart failure with systolic dysfunction after stroke. The aim of this study was to evaluate the effect of spironolactone in patients with preserved ejection fraction. This was a multicenter, randomized study that included 1722 patients in the spironolactone group and 1723 in the placebo group. All had symptomatic heart failure and ejection fraction greater than 45 %. At a mean follow 3.3 years, spironolactone showed no benefit in reducing the primary composite end point (HR = 0.89, CI 95% 0.77-1.04 , P = .14 ). Spironolactone did reduce the number of new hospitalizations for heart failure ( HR = 0.89 , CI 95% 0.63-0.89, P = .04). In the spironolactone group deterioration of renal function was observed and hyperkalemia, without this increasing incidence dialysis.

Conclusion:

Spironolactone in heart failure with preserved ejection fraction showed benefit only in terms of new admissions for heart failure at the expense of an increased risk of deterioration of renal function and hyperkalemia.

Original title: Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist